As part of our August newsletter, focusing on the devolved efforts of the UK to further global health, Andy Bacon, NHS England, explores the many ways in which England is contributing.

Volunteering has long been a valued activity across the NHS for the benefits it brings to overseas partners and in terms of the skills and competencies the volunteers bring back to their practice in the NHS and these are increasingly being recognised. Throughout the UK, NHS bodies are all taking an active interest volunteering and ensuring it is effective, efficient and provides benefits to all.

However, just as the British Army is sometimes described as a loose confederation of tribes (or regiments) that may on any given occasion coalesce to form a fighting formation; this same description may also now be applied to the NHS, which not only is separated into England and the UK’s 3 Devolved Administrations (with their own Departments of Health) but since the Health and Social Care Act of 2012, England itself is subdivided into 5 Arm’s Length Bodies (ALBs): 

  • NHS England,
  • NHS Improvement,
  • Public Health England PHE),
  • Health Education England (HEE),
  •  Care Quality Commission (CQC). 

Each has different roles with national and regional structures and it is important to understand these so as to use each part where it can add most value.  This brief summary seeks to explain the role of each in respect to Global Health and Volunteering, as they seek to provide system leadership and coordination and develop an evidence base for the benefits of this activity.

From system to individual and back again!

Through an English lens global health can be explored from a number of angles. From the individual volunteer, to the health partnership, and from public health support to larger health systems development frameworks.  Each element will be more of a focus for one part of the NHS system in England than another.

From the perspective of the individual volunteer, or the partnership, the relationship with the local provider Trust will be a key factor.  It is the Trust that will set the workforce policies that enable volunteering and these, whose backing and support will be vital to the sustainability of any partnership. 

However NHS Trusts do not normally operate in isolation and they will look to organisations like NHS Employers who provide advice and guidance for employers ( see who have staff wishing to volunteer overseas, either as part of their own organisation’s partnership or as part of another programme, to enable a level of consistency of policy and economy of effort,  so that things can be done once and then shared.

HEE are charged with ensuring the NHS has the personnel that it needs. Their vision is to provide the workforce, with the correct skills and values, in the right place at the right time to better meet the needs and wants of NHS patients – now and in the future. From a global standpoint they operate in both ways, supporting improved training and education by overseas placements and by recruiting suitably qualified and trained workers from overseas.  A true highlight of the reciprocity entailed with global health training and recruitment!

From national support to international progress

NHS Trusts in England are also governed and directed by the regulatory duties of NHS Improvement who offer the support these providers need to give patients consistently safe, high quality, compassionate care within local health systems that are financially sustainable. In terms of Global health they promote the benefits of international volunteering work to providers whilst ensuring that NHS funds are used effectively in ways that benefit NHS patients.

NHS England and the CQC and NHS Improvement are increasingly working closely together with a focus on the management of the health system; whether that is in terms of the efficient use of NHS resources (NHS England), the quality of the services provided (CQC) or the quality and sustainability of individual NHS providers (NHS Improvement). 

Global health security and the role of the NHS

PHE have a direct global role in ensuring that international elements of the population’s health are addressed.  The most obvious of these issues are international communicable diseases and disease resistance to treatment.  They exist to protect and improve the nation's health and wellbeing, and reduce health inequalities.

The global agenda: sustainable change

As the global agenda has moved transitioned from the Millennium Development Goals (MDG) to the Sustainable Development Goals (SDG), the importance of regulation, assurance and system change has become more apparent.  Therefore the skills of these bodies may become more prominent as volunteers are needed not just to deliver the clinical skills but to ensure that the overall health systems of low income countries deliver coordinated health services that are clinically-efficient and cost-effective.

Each of these bodies will need to learn from and contribute its knowledge, skills and workforce to the global health agenda.  This will ensure a mutual benefit through a well-motivated and trained workforce that can learn from others, contribute to improved global health and wellbeing and share its skills through philanthropy or for financial gain to middle income countries. 


Andy Bacon, Lead (Asst Head) Armed Forces, Central Team, NHS England